What is trichotillomania

Trichotillomania (TTM) is an obsessive-compulsive related condition, in which individuals feel a desire to pull out hair - usually the individual’s own hair, but can include the hair of other people, or fibrous materials. Pulling can occur anywhere on the body where hair grows, such as the scalp, eyebrows, eyelashes, beard and pubic areas.  Around 1-2% of people experience TTM, with women 10 times more likely to develop the disorder.

Pulling may be a voluntary/ intentional process or an involuntary/ unintentional process. It can include ritualistic behaviour, such as pulling certain kinds of strands or manipulating the hair in a particular method (rolling, biting or swallowing the hair). TTM could eventually lead to social and occupational withdrawal, as well as physical harm such as hair loss and damage, dental damage (if hair is bitten) and internal damage (if hair is swallowed). 

The Diagnostic and Statistical Manual of Mental Disorder (DSM) defines TTM as:

  • Recurrent pulling out of one’s hair resulting in noticeable hair
  • Repeated attempts to decrease or stop hair pulling.
  • Interruption of social and/or emotional functioning as a result of hair pulling 
  • Signs of trichotillomania are not due to any other physical conditions or mental disorders


Signs and symptoms

There are several indicators that an individual is experiencing TTM which often develop gradually over time. Thus, it is important to be able to recognise signs and symptoms in order to ensure timely intervention.

Signs of TTM usually appear around puberty. The most common signs and symptoms are:

  • Hair-pulling
  • Amounting desire to pull out hair
  • Feelings of shame about hair-pulling
  • Distress, which may lead to hair-pulling as a coping mechanism
  • Social and occupational inhibition due to feelings of shame or embarrassment
  • Hair loss or hair thinning
  • Damaged and/or infected skin
  • Teeth damage (if hair is chewed)
  • Hair balls within the body that need surgical removal


Causes of trichotillomania

There is no single cause of TTM. Research on TTM is still ongoing, but the main predisposing factors that have been currently identified include:

  • Genetics
  • Personality (perfectionist tendencies and pessimistic attitudes)
  • Environment (negative/ stressful events OR boredom)
  • Other mental illnesses

When to seek Help

It is important to note that TTM is not just a bad habit, but a mental health disorder that requires appropriate psychological treatment. If you or someone you know experience(s) symptoms of TTM, seek medical help. Furthermore, if ritualistic behaviours of eating hair occur, medical treatment is vital, as hairballs that form in the stomach may cause serious damage. Early intervention is recommended for the most effective recovery.


Treatments

Treatment is typically recommended by a psychiatrist or GP. The two most common approaches are medication and psychological therapy, which can be used alone or in conjunction with each other.

  • Medication - mainly used to reduce symptoms of trichotillomania; includes mood stabilisers and atypical antipsychotics.
  • Therapy - help an individual in learning how to process any feelings that may lead to hair-pulling and to effectively manage them; includes cognitive-behavioural therapy (CBT), specifically habit reversal training, and acceptance commitment therapy. 

Techniques to try to reduce hair-pulling urges

There are many ways that you can try to decrease the urge to pull hair. These include:

  • Competing responses - engage in activities in which hair cannot be pulled, including making a fist with the hands, using fidget toys, sitting on the hands, or handling objects such as stress balls.
  • Stimulus control - avoid triggers that may awaken the urge to pull hair, which can include wearing gloves or plasters on the fingertips, wearing accessories that cover the hair, cutting the hair short, avoiding certain locations or avoiding certain body positions
  • Mindfulness - live in the present moment and be aware of urges that may occur; may be done by keeping a journal or practising meditation.
  • Coping skills - try to reduce your stress level, which can be done through exercise, taking small breaks from work, taking a soothing bath, keeping a planner, or listening to music


Supporting someone with trichotillomania

Friends and family of individuals with TTM play a vital role in treatment. If your loved one is experiencing TTM, you can support them by:

  • Educating yourself on TTM
  • Spending time with them
  • Creating a supportive environment to help alleviate stress
  • Practicing active listening while talking to them
  • Becoming a part of their medical consultations